The prevalent age group, cause and site of pediatric facial bone trauma at two tertiary units in Pakistan

Abstract

Background: The pediatric oro-facial trauma is observed in Indian Subcontinent as well as in developing countries. The school group and teenage group children are frequently involved. Dento-alveolar fractures are common comparative to mandibular fractures whereas middle third of the face is exceedingly rare. The mandible is fractured at variety of sites in pediatric facial trauma. The condylar cartilage, developing permanent teeth and advancing growth, all result in injury at different sites of the mandible and hence the various treatment modalities are required to manage these fractures. In majority, the causes of fractures are accidental falls and road traffic accident (RTA). Method: 141 patients presented at Oral and Maxillofacial Surgery Department of Punjab Dental and Children Complex Hospitals, Lahore from September 2003 to December 2005. The age of the patients ranged from infancy to early teenage (>0 years to 15 years) with facial bone injuries. The children were divided into four groups; Group "A " (Infants), Group "B" (Pre-school), Group "C" (School) and Group "D" (Teenage). After initial examination, different radiographs (orthopantomograph, posterioanterior mandible and occipitomentalis views) were utilized to confirm the site and diagnosis. Different treatment modalities depending upon the site, bone involved and age group of the patients were used to manage the fractures. Few patients were managed conservatively. Results: The dento-alveolar trauma was noticed frequently in group "C" and "D" and it is 50.35% of the total facial bone trauma. The cause of the trauma in majority of the patients was by accidental falls. 40 patients were of maxillary dento-alveolar trauma and nine were of mandible. Twenty-two children had bi-maxillary dento-alveolar trauma. It was observed that the maxillary trauma was common in skeletal /dental class II div I cases. The next common bony trauma was of the mandible (45.39%). 50% of total mandibular fractures were from group "C". The site of the fracture in these patien ts was the body of the mandible and frequently associated with mandibular condyles (29%) whereas 9.37% of them had unilateral condylar fractures. This group had the highest frequency of mandibular fractures among facial bone fractures. Group `D` (20.31%) of total mandibular fractures had high male prevalence (80%). Maxillary fractures were 2.83% of the total facial bone trauma. The patients had Le Fort I or high Le Fort I fractures while one patient (presented 15 days after trauma) had Le Fort III fracture. The Le Fort III patient had fall from double story building and had head injury too. Two patients had trauma due to automobile RTA. All patients of maxillary fracture were from early age group "C" and there was no associated mandibular fracture in these patients. Zygomatic fractures were 1.41% of the total facial bone trauma. One patient had fracture from fall (stairs) and other had RTA. Conclusion: The patterns and sites of pediatric facial bone fracture vary within age groups. Majority of facial bone tr auma results in school going and early teenage groups with definite male predominance. Dento-alveolar and mandibular fractures are frequent with negligible mid face fractures. The pediatric facial bone fractures should be managed at their earliest to avoid complications.